Kelly R Wilson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

9580 Issued in MA

Practice address

875 Massachusetts Ave
Suite 71
Cambridge, MA 02139-3067

Phone

(857) 600-0875

NPI assigned

Aug 21, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Highland Psychological Associates, LLC

  • Clinical Psychologist
  • Cambridge, MA
  • NPI 1033453584
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1740596279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 HIGHLAND AVE",
            "address_2": "APARTMENT 1",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391040",
            "telephone_number": "650-906-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE",
            "address_2": "SUITE 71",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "857-600-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLY",
        "middle_name": "R",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-21",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "9580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willow Path Counseling, a Professional Clinical Counselor Corporation
• Emily K Wilner, PSYD
• Tele Wilson-Bahoun
• Eileen A Wilson
• Ellen F Wilson, PH.D.
• Loren Jay Wilson, DMD
• Lucy Wilson, RN
• Nicholas Wilson, P.T.
• Nikole C Wilson, PHD, LMHC
• Samuel B Wilson, M.D.

• Clinical Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.